1. Teaching Schoolchildren Pedestrian Safety: A Pragmatic Trial Using Virtual Reality David C. Schwebel 1, Daniel Rodriguez 2, Virginia Sisiopiku 1, Joan Severson 3, & Tabitha Combs 2 1 University of Alabama at Birmingham 2 University of North Carolina, Chapel Hill 3 Digital Artefacts, LLC

2. Epidemiology of Pedestrian Injuries  Despite improvements, annually: Over 4,100 American pedestrians killed Over 215,000 American pedestrians seriously injured  About ⅓ of injured pedestrians are children  Southeastern US has increased risk, perhaps due to climate, culture, and traffic patterns Pedestrian Fatalities Year

3. Pedestrian Behavior: A Complex Cognitive, Perceptual, and Motor Task  How do children cross the street?  Crossing at a “basic” street environment  Adding complexity: road environment factors Parked cars, obstructions, curves, inclines Route selection Distracted, drunk, or speeding drivers In NC, pedestrian “failing to yield” represents 14.7% of all crashes  Adding complexity: child factors Cognitive immaturity Impulse control Distraction In NC, darting represents 6.6% of all crashes

4. So, how do we prevent pedestrian injuries? A multifaceted approach  Traffic Environment Example opportunities: Roadway design, designated pedestrian crossing areas, traffic calming, pedestrian barriers and bridges  Drivers Example opportunities: Reduce speeding, reduce distracted driving, reduce drunk driving, increase awareness of pedestrians, increase compliance with laws and regulations  Parents and Other Adults Example opportunities: Supervision, Walking School Buses, Crossing Guards  Children Our current focus

5. How and when do we teach children?  What age? 2? 5? 7? 10?  What strategy? Films, games, websites Classroom teaching Streetside training Virtual reality  Efficacy, cost, practicality  Need multidisciplinary team and attention to technology

6. Virtual Reality  Allows safe engagement in the environment without risk of injury  Permits careful control of traffic but immersion in an environment that feels real and presents no risk of injury  Offers opportunity for repeated practice at the cognitive-perceptual task to be learned  Offers immediate feedback on safety of crossings

7. A Pedestrian Virtual Environment Prototype

8. The Environment: A Video Presentation PLEASE GO TO THIS LINK: http://www.psy.uab.edu/schwebel.htm

9. Background: Randomized Trial  Randomized controlled trial comparing: No training Training in the virtual environment Training street-side with an adult Training using computer software  240 children ages 7-8 recruited Behavior measured pre-intervention, post-intervention, and 6-month follow- up

10. Pedestrian Safety: Assessment Methodology  VR assessment 30 crossings, 10 at each of three “difficulty” levels: 25 MPH traffic and light volume of 8 vehicles/minute; 30 MPH/12 vehicles per minute; 35 MPH/16 vehicles per minute)  Field assessment Naturalistic setting with actual traffic “Shout” technique, 8 crossings “Two-step” technique, 8 crossings

11. Outcome Measures  Hits/Close Calls – instances when the child would have been struck by a vehicle in the real environment, or when the gap between the participant and an oncoming vehicle was less than one second  Attention to Traffic (not discussed)  Start Delay (not discussed)

12. Results: Hits/Close Calls In VR, streetside and VR training groups show similar decrease in hits/close calls In Field, all groups show increase post-training. VR, video, and control group show some decrease at follow-up General trend for decreases among VR and streetside training groups From Schwebel et al, in press, Health Psychology

13. Summary  VR seems to help children learn to cross streets safely  Individualized streetside training also is effective  Videos and internet programs show minimal evidence of efficacy  PROBLEM: how do we get lots of children into a VR pedestrian environment???

14. Solution: Community VR  Develop a VR that is light, portable, durable, and easy to use  Install and use in schools, community centers, after-school programs, religious institutions  Currently in development using children’s museum displays as a model

17. Pragmatic Trial  Conducted in community by community members  Research team involved only for assessments

18. Research Design  Pre vs. Post research design, evaluating children’s improvement following training  Thorough assessment of pedestrian safety prior to and after training in the VR Hits/close calls Start delay (delay entering safe traffic gap) Attention to traffic (looks left and right while waiting, divided by time)

19. Project Timeline  Pre-intervention assessments of children from Hemphill Elementary are ongoing  Virtual environment to be installed in Hemphill on March 31 and remain there for 3 weeks  Following installation at Hemphill, Virtual Environment will be moved to Bluff Park Elementary for 3 weeks  Assessment of children will continue in UAB Youth Safety Lab  Data available by Summer 2014, dissemination of results starting in Fall 2014

20. Acknowledgements  Digital Artefacts team  UAB students and staff: Anna Johnson and Mostafa Emeira  Early research: Leslie McClure, Elizabeth O’Neal, Anna Johnston, Award Number R01HD058573 from the Eunice Kennedy Shriver National Institute of Child Health & Human Development.  Current research: Grant # 2013-004S, Southeastern Transportation Research Innovation, Development and Education (STRIDE) Consortium, University of Florida and US Department of Transportation  Matching funds: UAB College of Arts and Sciences and ALDOT

21. Discussion and Questions Contact Information: David C. Schwebel, Ph.D. Professor of Psychology Associate Dean for Research in the Sciences University of Alabama at Birmingham 1300 University Blvd., HHB 571 Birmingham, AL 35294 USA Phone: 1 (205) 934-8745 Email: schwebel@uab.edu

22. FOLLOWING SLIDES  ONLY DURING QUESTIONS

23. Solution #2: VR over the Internet  Develop a VR that can be delivered via the Internet  Sacrifice some realism and immersion to provide dissemination power  Must provide adequate practice at the cognitive-perceptual task of crossing to yield learning  Currently in development stage. Feasibility demonstrated. See: http://pedsim.digitalartefacts.com/player/WebPlayer.html

24. Results: Attention to Traffic In VR, VR group showed increased attention post- training and others fairly flat. All groups show increase at follow-up, perhaps due to developmental processes In Field, VR decreases post-intervention and control at follow-up. Other groups fairly flat. Perhaps children have adequate attention to traffic at this age prior to training?? From Schwebel et al, in press, Health Psychology

25. Results: Start Delay In VR, streetside has increase and others decrease. VR shows greatest decrease post-intervention. Streetside shows large decrease at follow-up. In Field, pattern is similar but muted. Streetside reacts with post- intervention increase but decrease at follow-up. Others show some decrease, especially VR, at post-intervention. Good proxy for cognitive thinking process. VR training shows some evidence of efficacy, and efficacy similar to individualized streetside training. From Schwebel et al, in press, Health Psychology